Fact sheet

PREVENTIVE SERVICES COVERED BY MEDICARE CALENDAR YEAR 2007

Once limited by statute to providing coverage only for diagnosis and treatment of an illness, injury, or impairment of a body part, the Medicare program, through a series of legislative changes, now covers a broad range of preventive and screening services for beneficiaries who are enrolled in Part B. As more preventive services are added to the list of covered services, Medicare is working with physician and beneficiary organizations to get the word out and to encourage beneficiaries to make full use of the preventive benefits.

Below is a list of the Part B covered preventive services for 2007.

Service

Who and what

is covered?

How often can

I get this service?

Do I have to pay coinsurance or deductible?

Flu Shots

All people with Medicare.

Once a flu season, or more frequently if medically necessary.

No coinsurance or deductible.

Pneumococcal Shot

All people with Medicare.

Once in a lifetime

No coinsurance or deductible.

Hepatitis B Shots

People with Medicare who are at medium to high risk.

One series if ordered by a doctor.

Coinsurance and deductible.

Initial Preventive Physical Examination

(The “Welcome to Medicare” physical exam)

All new enrollees in Medicare Part B may receive an exam that includes medical and social history review, and physical examination and electrocardiogram (ECG), with counseling, referral and a written plan for additional preventive services that are needed.

NEW - In 2007, people with Medicare who are at risk for abdominal aortic aneurysms may get a referral for a one-time screening ultrasound at their Welcome to Medicare Physical Exam.

One time only within the first 6 months you have Medicare Part B.

Coinsurance and deductible.

You pay 20% of the Medicare-approved amount with no Part B deductible for the Abdominal Aortic Ultrasound screening.

Cardiovascular Disease Screenings

All people with Medicare Part B may receive assessment of blood lipid levels.

Every 5 years.

No coinsurance or deductible.

Diabetes Screenings

· Those with Medicare with 2 or more of the following: age 65 or older, overweight, family history of diabetes, or a history of gestational diabetes or delivery of a baby weighing more than 9 pounds.

· Those with Medicare who have high blood pressure, dyslipidemia, obesity, or history of high blood sugar

May receive a test for elevated blood glucose

· 1 screening per year if you were never tested or if you were previously tested, but not diagnosed with pre-diabetes.

· 2 screenings per year if you are diagnosed with pre-diabetes.

No coinsurance or deductible.

Pap Test and pelvic screening exams

All women with Medicare.

· Every 24 months.

· Once every 12 months if you are high-risk or if you are of childbearing age and have had an abnormal Pap test in the past 36 months.

Coinsurance but no deductible for the pelvic exam. Beneficiary pays nothing for the lab analysis.

Screening Mammograms

Women with Medicare who are age 40 or older.

Once every 12 months.

Coinsurance; no deductible.

Women with Medicare who are age 35-39.

One baseline mammogram.

Colorectal Cancer Screening

People with Medicare age 50 or older except there is no minimum age for a screening colonoscopy or barium enema as an alternative to colonoscopy.

· Fecal occult blood tests once every 12 months

· Flexible sigmoidoscopy- every 48 months or once every 120 months after having a screening colonoscopy.

· Screening colonoscopy- every 24 months if you are at high risk; every 120 months if you are not at high risk.

· Barium enema - every 24 months if you are at high risk; every 48 months if you are not at high risk.

No coinsurance or deductible for fecal occult blood tests.

All other tests, coinsurance and deductible.

NEW: Starting in 2007, Medicare will waive the Part B deductible for the colorectal screening benefit. Coinsurances still apply.

Prostate Cancer Screening

All men with Medicare over age 50.

Digital Rectal Exam: once every 12 months

Prostate Specific Antigen (PSA) Test: once every 12 months

· Coinsurance and deductible for digital rectal exam.

· No coinsurance or deductible for Prostate Specific Antigen Test.

Bone Mass Measurements

People with Medicare whose doctors say they are at risk for osteoporosis.

Every 24 months (more often if medically necessary

Coinsurance and deductible.

Glaucoma Tests

People with Medicare who have diabetes, a family history of glaucoma, are African American and age 50 or older, or are Hispanic-American age 65 and over.

Once every 12 months

Coinsurance and deductible.

For more details about these services, get a free copy of the Guide to Medicare’s Preventive Services (CMS Pub. No. 10110) at www.medicare.gov on the web. Select “Publications.” Or, call 1-800-MEDICARE (1-800-633-4227) and ask for a copy. TYY users should call 1-877-486-2048.